PCTs: funding overhaul needed

Primary care trusts should be able to achieve the proposed public service agreement target of cutting emergency inpatient bed days by 10 per cent by 2008, according to senior NHS figures.

But the cuts will rely on PCTs introducing effective chronic-disease management systems, and the target may contribute to a change in the current payment by results arrangements.

One PCT chief executive said that the new funding system would have to be overhauled to remove the 'perverse incentives' for acute trusts to retain as much work as possible if the 10 per cent target was to be hit. The chief executive said the Department of Health was reviewing the system to help PCTs.

NHS Alliance chair Dr Michael Dixon said the target would require 'a lot of reconfiguration', and he said it would take the system a couple of years to get to grips with the consequences of payment by results and foundation trusts.

He added that it would also take time to put good-quality local care in place, but he commented the proposed target was a 'lovely balance' between the need to give the Treasury something measureable, and a realistic goal for PCTs to aim at.

Earlier in the process of drawing up the PSAs, DoH officials considered a new target to reduce inappropriate admissions by 30 per cent (news, page 3, 22 April).

Emergency care czar Professor Sir George Alberti said such a target would have been too blunt a tool, and that short hospital admissions were often necessary as part of an individual care package.

Others pointed out that cutting admissions would mean a simple headcount and would not take into account management of the patient throughout the whole system.

But Sir George said he believed the new target would be 'challenging but achievable', assuming that effective chronic-disease management systems were introduced countrywide.

Primary care czar Dr David Colin-Thomé said the targets would not be final until signed off by health secretary John Reid, but he said that if the 10 per cent goal was adopted it should be achievable. He said evidence from this country and the US showed that such a target would not be 'overly ambitious'.

Dr Colin-Thomé pointed out that hospital stays were much longer for older people in the UK than abroad, offering scope for reducing bed days.

South Yorkshire strategic health authority chief executive Mike Farrar would not comment specifically on the document, but said a lot of work had been done to get the system into equilibrium on the supply side, and now it was time to tackle demand.He said there was a risk that unmet need could be discovered through the new chronicdisease register established as part of the new general medical services contract, which would make the target harder to hit.